Written by Eric Friedland-Kays, Senior Clinician and Development Manager

I love this quote by E.F. Shumacher, who wrote the amazing book, Small is Beautiful, Economics as if People Mattered:

“We must do what we conceive to be the right thing, and not bother our heads or burden our souls with whether we are going to be successful. Because if we don’t do the right thing, we’ll be doing the wrong thing, and we will just be part of the disease, and not a part of the cure.”

So much of the professional mental health field is struggling with a chronic problem of diagnosis and finding quick fixes. One reason this is a problem is because it limits the possibility of supporting sustainable change. True, meaningful, and lasting change is not always quick and is not often based upon diagnostic criteria. Healing through relationship is most plausible when we act with integrity, maintaining presence with ourselves within the environment and in each new moment.

I would like to focus on a few principles of how mental health support through community and relational integration is one way of describing how Windhorse engages in healing. This article will include examining some ways the Windhorse program offers an authentic, contemplative, and interactional answer to an overly medicalized mainstream paradigm of mental health.

Interconnectedness: At Windhorse, we utilize a uniquely powerful combination of authentic one-on-one relationships that grow over time within a dynamic, efficient team process. This consists of a circle of people who spend quality time together over the duration of the Windhorse program. The person receiving services is not in the middle of this circle but rather an empowered member of the team, just like the counselors, the psychotherapist, the nurse, the housemate, and the team leader. We connect to our common experience, join our lives together, and cultivate a sense of collaboration, trust, and connection. Difficulties and tensions arise, along with joyful ease, and we work with whatever actually arises within the relationships. As a greater engagement in non-treatment activities is built into the life of the client, those relationships in the greater world continue to cultivate a more fulfilling life.

Lynn Hoffman, author and one of the most innovative influences on family therapy, wrote about “the art of with-ness, as opposed to about-ness.” She says that “with-ness” activities operate on a felt sense level, rather than being stuck in adhering to rules that guide the therapist. In this relationship, the exchange that happens bypasses typical hierarchies. Therefore, rather than a pre-arranged goal the result will be spontaneous and intuited through the shared bonds that develop between the people engaged with one another.

Complexity: Systems, including our own bodies and minds, and most social groupings, tend to be complex. Success, in the way that I believe Schumacher was suggesting, must come from a realistic adherence to the complex nature of all issues within any mental health disruption in individuals. At Windhorse, rather than trying to fix a “problem’, such as a diagnosis, we make use of the reality that much of life is uncertain, and we value the cultivation of curiosity about the steps on the journey of a life in relation to others. We are not intending to fix problems so much as making efforts as a group to organize around clinical polyphony. This includes seeing to it that all voices are heard and recognizing that each one of us is uniquely multi-faceted. We value the understanding that each of us has biases, and thus we endeavor to hold our assumptions lightly, notice that we have biases and judgments, and try to account for these as part of the reality. Correspondingly, we endeavor to communicate and listen well to each other.

Growth: In the same way Peter Senge describes what he calls “Learning Organizations,” as agencies that use shared visioning to develop and transform themselves, it is crucial that healing sources deliver services that are open to one another and willing to adapt to the reality of the current situation – rather than being stuck in a particular modality of treatment. We continue to learn and develop so that each unique client and team that comes together has fresh new meanings that are allowed to emerge.

The “right thing,” in regards to the quote by Shumacher, is always going to be seen subjectively. On a team working with a client we cannot expect that all will have the same view as to what to do, or believe, or how to act. But we have a chance to move with the play and vicissitudes of the shared experience on a team if we let go of reasoning that caters to preconceived notions of what will be successful. The only “success” might be a committed intention to regard relational shared experience as valuable. The result will be whatever fruits are harvested from the playing out of that collaborative social experience.

I think of Shumacher in this topic on community integration and healing because he knew that everyone’s life path and each person’s truth is uniquely their own. He knew, as Mihaly Csikszentmihalyi, author of Flow, said, “A joyful life cannot be copied from a recipe.” As we examine what makes a healthy environment where healing is possible, we need to recognize that each piece within that environment has a part of the picture to represent. And if any of those parts is not allowed freedom of expression – or if any part is not given adequate facilitation to be given the chance to emerge – something will be lost and the healing may be unfulfilled. I am speaking of a collaborative team, a close family structure, a multitude of parts within a single individual, and more. All are complex systems that require synchronicity, openness, and expression. We might even say that each of these systems has an overall soul that desires manifestation of its wholeness. A realization of this kind may well result in both individual and communal healing.

The intention of this article is to explain the Polyvagal Theory, and to relate it to the Windhorse approach.This theory was developed by Stephen Porges, and has great relevance to “basic attendance”and Windhorse, which puts meaningful relationships as the basis of healing from extreme states of mind.Polyvagal Theory is a tool for working with trauma as well as a tool for understanding social connection and communication in general. This Fall, Deb Dana, a colleague and co-author with Porges, conducted an experiential training for Windhorse staff to learn about this approach.

The Vagal Nerve and Our Nervous System

According to Porges, “We all come from dysfunctional families.The issue is not whether our family was dysfunctional but whether we can put meaning to the experience of our lives.”

Our autonomic nervous systemis all about safety.Polyvagal Theory offers precise science to understanding how the vagus nerve, one part of this system, which connects the brain, to the heart, to the viscera (the organs of the belly), relates to our human ability to connect and communicate with each other.Learning about the vagus nerve allows us to understand our coherent human nervous system and how it predictably relates to stimuli it encounters as varying degrees of safety and danger.

This important nerve is aptly named by the latin root of “vagus,” which means “wander,” because of the far reaching connection it has throughout the body.Previous theories explained thatthe parasympathetic nervous system, through the calming effect of the vagus nerve, worked in opposition to the sympathetic nervous system.The sympathetic nervous system energizes us for physical action in times of need by increasing our heart rate and blood pressure, while simultaneously putting other functions like the digestive system on hold.This system enables us to run from a dangerous animal or to act quickly to deal with crisis without having to stop and think about it.This traditional model noted that the parasympathetic nervous system gets us back to normal homeostasis when we are no longer in need of such extreme reaction to a stressor.

The Autonomic Nervous System – Communication and Connection

What Porges provides is a more complex scientific understanding of a three-part hierarchical model and how the vagus nerve is directly related to a coherent system of communication and connection within the autonomic system.

Porges coined the term “neuroception” to refer to our innate unconscious awareness through the autonomic nervous system to influences in the body, in the environment, and in interactions between people.In other words, we detect dangers before we have time to think about it.This tells us about the subtle sense of safety or danger that potentially influences any interaction in the world

Polyvagal Theory describes the autonomic nervous system has having three subdivisions that relate to social behavior and connection.The oldest of these subdivisions is the “dorsal vagal,” a part of the parasympathetic nervous system thatenables us to shut down, or “freeze” when a situation of danger feels uncontrollable and we are overwhelmed.The second is our sympathetic nervous system, or “fight/flight,” system.And the most evolved and complex of the subdivisions, is our mammalian parasympathetic social communication and social engagement system – the ventral vagus.This is a very complex network of fast, myelinated neural fibers originating in the brainstem that dictates our heart rate, breathing, hearing, facial muscles, and vocalizing.

Polyvagal Theory is hierarchical, meaning that all three of these subdivisions follow a natural order depending on the neuroception of safety or danger in the situation.If the environment is detected as safe, we are free to use the ventral vagal social engagement system, which means we are relatively free be ourselves, express our own feelings, use facial expression easily, and use a modulated voice pattern.Also, our heart rate is relatively calm, we breathe freely, and we filter out human language from background noise.Whereas, if we are not detecting the environment as safe, we fall into a fight or flight, survival mode (this is the aforementioned “sympathetic nervous system” taking over).And if that system fails too, and we continue to feel unsafe, we naturally fall back into the freezing or shutting down dorsal vagal mode. In these more primitive modes, much of the aforementioned capacities are turned off, leaving a person with far less ability to relate to the world socially.

Trauma and the Polyvagal Theory

When it comes to post-traumatic stress, all of these subdivisions are reacting not simply to the immediate safety or danger in their environment, but to an interaction internally between the immediate environment and a sense of triggering activity based on past life events. Therefore, if someone experienced an event in childhood in which they did not feel safe, an event in their present adult life might echo such an experience internally, and this person may fall back on the more primitive neural systems of subconsciously needing to fight off, flee, or shut down in order to survive.

Each of us experienced some degree of trauma in our early lives.Whether it was an event that brought a great fear or we felt a deep lack of support in a significant situation, or whether it was a series of events that gave us fear, confusion, or a sense of not being safe.Any of these experiences may have remained in our nervous systems and emerge to add fear to situations later in life that remind our inner system of the danger.

Responses within ones’ inner system may be overt or subtle. This is why it can be confusing for a support person, friend, or family member if they are not seeing the internal mechanism happening for the person they are with.They might think the person is reacting too strongly with anger, for example, or perhaps shutting down, to what may seem like fairly safe conditions.Recognizing that the response to the situation is real and valid based on the person’s neuroception is extremelyimportant for a counselor or therapist.Understanding that there is no foundation for blame, that the response is not a conscious decision, helps to not take the reaction personally and contributes to safety.

Polyvagal and Windhorse Basic Attendance

What is helpful for a Basic Attendant of any form (in this broad definition I am including any therapist, counselor, housemate, nurse, mentor, friend, family member, or any other caring person in contact with someone in a mental health struggle) is to notice what seems to actually be happening for this individual with whom they are interacting, and appreciate the need for cultivating safety in the environment, including using their own facial expressions, vocal prosody, and even subtle movements.Also, in doing this, it is helpful to notice what seems to be happening in one’s own body and nervous system as one is in contact with the person needing support.

A key to the Windhorse work is cultivating an environment that is as safe as possible, and having interpersonal exchange within that environment.The social world and so much of what we encounter in our daily lives is affecting our nervous system, and in varying degrees it can be anxiety-producing or outright scary.At Windhorse, we want folks to be more engaged in their lives and be capable of, and interested in taking the risks of living in the world with others.We want to build a sense of safety so that risks can be taken and edges of growth can be tolerated.

From a polyvagal perspective, the autonomic nervous system is the foundation upon which all lived experience exists.It explains how we move through engaging with the world (of activity and of interactions with people) through connecting, disconnecting, and attuning.

Each of us experiences shame in some moments.Many folks seeking mental health services have struggled with school, or had to leave their school, or struggled with jobs, with relationships, etc.And unfortunately, society gives the message directly or indirectly that they have failed.Our mental health and education system often uses terms like “failure to launch” for young people who are deemed to have not realized their potential.

A more useful paradigm for recovery recognizes how the individual has successfully managed to navigate the risks, traumas, and various predicaments of their life.As Deb Dana says, “reducing shame makes room for curiosity and compassion.”Polyvagal Theory helps us understand that behaviors are manifestations of our internal nervous systems taking actions in the service of survival.People develop habits based in early adaptive survival responses, and these habits naturally continue into adulthood.When we can recognize how these responses once served a person by helping them tolerate otherwise seemingly unbearable circumstances, we are able to cultivate a sense of appreciation for how an individual has survived, adapted, and learned through the difficult experiences and predicaments of their life .This leaves us with the option of a recovery paradigm that creates meaning out of the varied experiences within an individual’s body-mind-spirit continuum, rather than putting emphasis on a need to overcome the so-called “mental illness.”

Deb Dana says, “we come into this world wired to connect.”What Polyvagal Theory is helping us to see, through scientific understandingof how the autonomic nervous system works, is how our innate drive to survive in the often challenging predicaments of our lives can interact with our innate longing to connect with others.Each of us has more capacity to engage socially when our nervous system feels safe, and contrastingly we have more need to fight, flee, or freeze when our nervous system is sensing danger.

“Basic Attendance” at Windhorse, is potentially a path to learning safety and learning more about ones’ mind as it interacts with the outside world.A challenge of the practice of basic attendance is that as these one-on-one interactions occur, habitual patterns of fighting, fleeing, and freezing may naturally emerge in the relationship.These are the complex edges of tolerance that need to be supported so that one can learn and grow from them.On one hand, an individual may not be able to shift stuck habit patterns if they avoid environments and people with whom we have any discomfort.And on the other hand, one also needs to remain relatively safe and not simply throw oneself so far outside their comfort zone that their nervous system becomes activated and can only remain in fight, flight, or freezing modes.

As Deb Dana notes, “Polyvagal Theory offers a roadmap to work with autonomic activation and build regulation and resilience.”If we understand how to read this roadmap, and make it more of our habit as people in service of others and ourselves, to build safety in our interactions, we may likely be contributing to cultivating less shame and instability in our world.Some of the community integrating healing benefits of this may be a feeling of connection, safety with vulnerability, having flexible options in times of stress, consciously communicating, and a greater capacity to authentically receive and offer love.

On a mild spring weekday in April, several Windhorse clinicians braved the unpredictable traffic of Boston to attend an all-day conference called “Attachment and Addiction: Harm Reduction and Relational Approaches,” that was co-sponsored by Ellenhorn and Psych Garden. This is a timely and resonant topic for Windhorse IMH, as we work from a “harm reduction” perspective grappling with the implications of honoring a view around substances and addictions of any sort, that is much more broad than the more mainstream view of an abstinence-only, “just say no” approach.

A Short History of Harm Reduction

The term “harm reduction” holds for some an outdated definition of needle exchange for substance abusers, which is a controversial and limited sense of a broad and increasingly important concept of support for people with addictions. This conference aimed at pointing out that “harm reduction” consists of many practical strategies and ideas centered on curtailing negative consequences associated with drug use. Harm Reduction can also be seen as a social justice movement that respects and believes in the rights of folks who abuse substances. From a Windhorse perspective, this may be seen as simply honoring the person “where they are,” as opposed to expecting an individual to be only where we want them to be and then trusting and cultivating authentic relationships that allow insight and health to emerge.

There are many elements of Harm Reduction philosophy that deeply resonate with Windhorse philosophy. Ross Ellenhorn in his opening to the Conference, brought up three names of harm reduction researchers I want to emphasize, Gabor Maté, Bruce Alexander, and Dr. Carl Hart. Maté, who wrote the remarkable book, “In the Realm of Hungry Ghosts: Close Encounters with Addiction,” which integrates detailed first-person accounts with strong scientific data, asks us to consider “Not why the addiction, but why the pain?” Maté points out that society has tended to treat only the symptoms of drug use, missing the underlying elements that are the root of the predicament. Alexander, a professor and author who wrote Globalization of Addiction, talks about how individuals in society have turned to drugs and other addictions because we feel disconnected from each other. And in another perspective that blends well with Windhorse work, neuropsychopharmacologist Dr. Hart studied social relations in the United States and said “The key issue is environment,” as he detailed the ways that our society creates stresses that cause dependency and drug use. Hart is known for studies that point out how crack was not what caused inner city problems, as commonly believed, but that it was conversely a system of oppression in society, that led to the crack problem. Hart notes that if we understand and work with the systems creating a need for drugs, we tend to have models of healing that offer more human dignity and thus end up being more effective.

Our society has commonly treated addiction to alcohol and substances with “tough love” and treatment models that often disempower the individual in trouble. In truth we are all prone to addictive behavior. Furthermore it makes sense that when one is in pain of any sort, we have a reasonable inclination to kill or escape from the pain or find any temporary relief and pleasure from the suffering. The stresses of living in society are at the root cause of addictive behavior. Studies show that support in the form of kindness and empathy work better than tough love in cultivating sustained recovery from addictions.

Harm Reduction: Abstinence vs. Biopsychosocial Model

Thankfully, a bio-psycho-social model is recently being seen as an effective way of dealing with addictions and mental health. Windhorse has always manifested this approach to mental health recovery in general. This approach of dealing with addictions, taking into account the biological, behavioral, psychological, and environmental elements of health, consistent with Harm Reduction approach, makes sense and is backed by science. Compare this with an “abstinence-only” approach that has not been proven to be most effective. I need to point out that Harm Reduction includes an abstinence perspective, rather than being at odds with it. Abstinence, of course, is perfectly consistent with this model so long as the individual in recovery is choosing this behavior, as opposed to doing it because someone else (or a treatment program) tells them to.

Dr. Mark Green, of Psych Garden, a dual diagnosis center in Belmont, MA, based in integrative treatment, explains how the attunement system works within the body through dopamine and endorphins working on a reward and error system, leaving us susceptible to anything that throws our homeostasis out of whack. Thus, a reason why abstinence often fails is that when opioids are taken, they can usurp the natural internal homeostasis system, creating tolerance within the body to this newer internal biological structure that was an adjustment to the opioid.. If we suddenly take away the drug, the person may be left with their internal system out of control in craving the opioid in order to return to homeostasis. This is why methadone, though a highly addictive drug in itself, has been an effective harm reducing step from heroin addiction. Although the action of methadone is similar to other human-made opioids, methadone works on parts of the brain and spinal cord to block the “high” effect of using heroin or other opiates. Methadone also helps reduce cravings and withdrawal symptoms caused by using these drugs. An individual is better off with methadone than heroin, and the individual may be more capable on methadone to be in a mental and physical state that enables them to take more steps in the direction of harm reduction and recovery. Steps like relational approaches to treatment and therapy are more accessible when a person is not completely lost in their dependency to an addictive drug.

Windhorse treatment, of course, places great emphasis on relationships as a foundation for healing. So, working with folks who are using substances must also include an interrelational dynamic with their Team and any addictions with which they are engaged.

Where Harm Reduction Theory and Windhorse Philosophy Meet

This brings up a topic of goal-setting that arose in dialogue amongst Windhorse clinicians who attended this conference, and seems to be a place where Harm Reduction theory and Windhorse philosophy meet. At Windhorse, we do not engage in typical “Treatment Plans” like programs that often begin their work with clients by establishing some written plan that sets the stage for treatment. The Windhorse approach is not adverse to intentions and planning. In our admissions process with prospective clients, for example, we are actively looking at any vision the individual has for themselves stepping into their future. We may also be interested in what others, including family and friends and other therapists and clinicians who know the individual, may be envisioning for their treatment or future. We may hold any or all of theseintentions in varying degrees of importance.

An overall objective in the Windhorse approach is collaborating with an individual in discovering a more essential, life-affirming perspective resonant with that unique individual. The Team aims to maintain presence in their relationships, not be overly distracted by history or the future. Over time and through authentic relationships on the individual’s Team, meaningful and feasible goals organically emerge. This is not a magical process but a very real one that comes through a combination of supports and ways of perceiving a given individual’s experience. The relational element of recovery is part of the process, since it is through this dynamic process of genuine social relationships that trust-building, collaborative activity, and honest dialogue leads to understanding oneself and one’s social world better.

As we cultivate an environment where we treat others more in the manner of Maté’s empathic question “Not why the addiction but why the pain?”, we can be aware of ourselves in relationship with that question and to the individual with whom we are interacting, thus allowing a certain level of openness to ourselves engaged with someone who is experiencing their personal journey of recovery.

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Note: Photos for this post were sourced from Harm Reduction Coalition campaign. Windhorse is not officially affiliated with this site or organization and may or may not agree with its content.